超声引导下仰卧位腰丛阻滞与髂筋膜阻滞对高龄患者髋关节置换镇痛的比较:单中心、随机、对照临床试验  

Ultrasound-guided lumbar plexus block in supine position versus iliac fascia block for analgesia in elderly patients undergoing hip replacement: a single-center, randomized, controlled clinical trial

作　　者：陆小龙 俞学锋 胡四毛 郑学磊 李琼 刘勇 王盘如 彭建敏 梅斌[2] Lu Xiaolong;Yu Xuefeng;Hu Simao;Zheng Xuelei;Li Qiong;Liu Yong;Wang Panru;Peng Jianmin;Mei Bin(Department of Anesthesiology,Lu’an Civily Hospital,Lu’an 237000,Anhui Province,China;Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui Province,China)

机构地区：[1]六安世立医院麻醉科,安徽省六安市237000 [2]安徽医科大学第一附属医院麻醉科,安徽省合肥市230022

出　　处：《中国组织工程研究》2019年第8期1149-1154,共6页Chinese Journal of Tissue Engineering Research

基　　金：六安世立医院青年基金培育计划;项目负责人:陆小龙~~

摘　　要：背景:高龄患者接受髋关节置换,手术的麻醉是很重要的环节。腰丛以及髂筋膜阻滞都是髋关节置换常用的麻醉阻滞方法。目的:试验拟观察超声引导下仰卧位腰丛阻滞与多角度多点髂筋膜阻滞在高龄髋关节置换患者围术期镇痛效果,以筛选出对此类患者的最佳镇痛方案。方法:研究为前瞻性、单中心、随机、对照临床试验。拟收集中国安徽省六安世立医院的高龄髋关节置换住院患者208例,随机分为2组,每组104例,腰丛组行仰卧位腰丛神经阻滞后联合喉罩全身麻醉,髂筋膜组行多角度多点髂筋膜神经阻滞后联合喉罩全身麻醉,麻醉后两组进行髋关节置换。术后随访24h。试验经六安世立医院医学伦理委员会批准(批准号:PJ2018-001,审批时间:2018年3月),方案版本号1.0。参与试验的患者在充分了解治疗方案的前提下签署"知情同意书"。结果与结论:研究的主要结局指标为术后24 h以目测类比评分法评估术后镇痛效果;次要观察指标为术后2,6,12 h的目测类比评分变化,术中各时间点[喉罩置入时(T0)、手术切皮时(T1)、手术扩髓时(T2)、假体植入时(T3)、缝切口时(T4)、入复苏室后(T5)]心率、平均动脉压和血氧饱和度变化,术中舒芬太尼、佩尔地平、麻黄碱用量,术后2,6,12,24h静脉自控镇痛用药总量及不良反应发生率。课题组前期(2018年3月至9月)已完成了60例高龄髋关节置换患者的小样本试验结果,腰丛组30例术中舒芬太尼、佩尔地平及麻黄碱的用量明显低于髂筋膜组(P <0.05);髂筋膜组30例T2至T5时的心率与腰丛组相应时间点相比明显升高(P <0.05),且在T1,T2,T3,T5时心率大于同组T0 (P <0.05);同时髂筋膜组T1至T5时的平均动脉压高于腰丛组(P <0.05),在T1至T4时的平均动脉压高于同组T0 (P <0.05);而腰丛组T3,T4时的平均动脉压略低于同组T0 (P <0.05)。腰丛组术后6,12,24 h疼痛目测类比评分低于髂筋膜组(PBACKGROUND: Anesthesia is an important part of hip replacement in older adult patients. Lumbar plexus block and iliac fascia block are common block methods in hip replacement. OBJECTIVE: To investigate the analgesic effect of ultrasound-guided lumbar plexus block in supine position versus multi-angle multi-point iliac fascia block during hip replacement in older adult patients to screen the optimal analgesic regimen. METHODS: This prospective, single-center, randomized, controlled trial will include 208 older adult patients scheduled to undergo hip replacement from wards of Lu’an Civily Hospital in China. These patients will be randomly assigned to two groups(n = 104/group). In the lumbar plexus block group, patients will undergo lumbar plexus block in supine position, general anesthesia using a laryngeal mask airway and later hip replacement. In the iliac fascia block group, patients will undergo multi-angle multi-point iliac fascia block, general anesthesia using a laryngeal mask airway and later hip replacement. After surgery, all patients will be followed up for 24 hours. This study was approved by Medical Ethics Committee of Lu’an Civily Hospital in China in March 2018(approval No. PJ2018-001). The study protocol is 1.0. Patients participating in this study will sign informed consent after fully understanding the study protocol. RESULTS AND CONCLUSION: The primary outcome measure of this study is Visual Analog Scale score at 24 hours post-surgery, which is used to evaluate postoperative analgesic effect. The secondary outcome measures of this study are Visual Analog Scale score at 2, 6 and 12 hours post-surgery, heart rate at various time points during the surgery [laryngeal mask placement(T0), surgical incision(T1), surgical reaming(T2), prosthesis implantation(T3), incision suture(T4), and resuscitation(T5)], mean arterial pressure, blood oxygen saturation, intraoperative sufentanil, perdipine, and ephedrine dosages, total amount of intravenous patient controlled analgesics at 2, 6, 12, and 24 hours po

关 键 词：超声引导 腰丛神经阻滞 髂筋膜神经阻滞 髋关节置换 高龄髋关节置换 关节置换麻醉 术后镇痛 组织工程 关节成形术 置换 髋 舒芬太尼 

分 类 号：R453[医药卫生—治疗学] R614[医药卫生—临床医学]